肺移植手术技术日臻成熟，然而急、慢性排斥反应仍严重影响肺移植受者的长期生存率。免疫抑制治疗可以减少肺移植术后排斥反应发生率，但目前免疫抑制方案尚无统一标准。为了进一步规范我国肺移植免疫抑制治疗以及排斥反应诊疗，中华医学会器官移植学分会从肺移植免疫抑制剂应用的基本原则、免疫诱导和维持治疗以及不同类型排斥反应的诊断和处理等方面，制订中国肺移植免疫抑制治疗及排斥反应诊疗规范(2019版)。

心脏移植术后并发症主要有术后出血、低心排综合征、急性右心衰竭、心律失常、消化道并发症、中枢神经系统并发症、急性肾功能衰竭和术后感染。所有并发症均可严重影响心脏移植受者术后的生存质量。为了进一步规范心脏移植术后并发症的诊断和治疗，中华医学会器官移植学分会组织心脏移植专家，总结相关国内外最新进展，结合国际指南和临床实践，从术前对供、受者进行准确评估、围术期进行针对性预防、积极治疗并发症病因以及保护心功能等方面，制订中国心脏移植术后并发症诊疗规范(2019版)。

Severe donor organ shortage has greatly restricted the clinical application of organ transplantation. In China, the utilization of extended criteria donor (ECD) grafts, including donation after cardiac death (DCD) and steatotic grafts have increased year by year, leading to a significantly higher incidence of early allograft dysfunction and other post-transplant complications, as well as a significantly reduced overall survival. To standardize the clinical use of ECD grafts and improve recipients′ outcome, the Liver Transplantation Group, Branch of Organ Transplantation of Chinese Medical Association and Organ Transplantation Physicians of the Chinese Medical Doctor Association have organized experts to summarize and discuss the clinical diagnosis and management of ECD grafts in China by combining the evidence-based medical basis and Chinese clinical practice experience, and by drawing on the relevant domestic and international literature, thereby developed the "Chinese Clinical Practice Guidelines for Extended Criteria Donor Grafts in Liver Transplantation." This guideline addressed a series of recommendations in a scientific and standardized way in terms of donor-recipient status and risk prevention, regarding to DCD grafts, steatotic grafts, small-for-size grafts, elderly donor grafts, and hepatitis B virus-infected grafts. Its purpose is to establish a scientific evaluation and application framework for ECD grafts, balance the risks of organ utilization and survival benefits, and ultimately enhance overall survival and life quality of liver transplant recipients in China.

To investigate the effect of upper gastrointestinal hemorrhage on the efficacy of liver transplantation in the treatment of cirrhotic portal hypertension (PHT).

The clinical data of the recipients who underwent liver transplantation due to cirrhotic PHT from January 2005 to September 2017 in the Department of Hepatobiliary Surgery of the Chinese People′s Liberation Army 900th Hospital of the Joint Logistics Team were analyzed retrospectively. All the recipients were divided into bleeding group and non-bleeding group according to whether they had the upper gastrointestinal bleeding occurred before liver transplantation. The parameters including gender, age, amount of intraoperative bleeding and blood transfusion, days of hospitalization, cost of hospitalization and the liver function indexes before and after liver transplantation were observed. Wilcoxn signed rank sum test was used to compare the age, the amount of intraoperative bleeding and blood transfusion, the cost of hospitalization and the days of hospitalization between the two groups. ALT, AST, total bilirubin (TBil), albumin (ALB) and prothrombin time (PT) between the two groups were compared by group t test. Two-factor repeated data analysis of variance was used to compare the liver function indexes at each time point within 1 week after liver transplantation between the two groups. Chi-square test was used to compare the gender and primary diseases of the two groups. P<0.05 means statistically significant.

A total of 80 cases (61 males and 19 females, aged 7-71 years old) underwent liver transplantation due to cirrhotic PHT. Primary diseases included 71 cases of posthepatitic cirrhosis, 5 cases of biliary cirrhosis, 2 cases of hepatolenticular cirrhosis and 2 cases of alcoholic cirrhosis. All subjects underwent orthotopic inferior vena cava reverse perfusion liver transplantation. There was no significant difference between the bleeding group (39 cases) and the non-bleeding group (41 cases) in gender, age, primary disease, preoperative liver function indexes, amount of intraoperative bleeding and blood transfusion, cost of hospitalization and days of hospitalization (P all>0.05). There was no significant difference in ALT, AST, TBil, ALB and PT between the two groups at all time points after operation (P all>0.05). The levels of serum ALT on the 3rd, 5th and 7th day after operation in both groups were lower than those on the 1st day after operation. The levels of serum ALT on the 5th and 7th day after operation in both groups was lower than those on the 3rd day after operation. The level of serum ALT on the 7th day after operation was lower than that on the 5th day after operation in the non-bleeding group (P all>0.05).

The history of upper gastrointestinal bleeding before liver transplantation had no effect on the early liver function after liver transplantation in the treatment of cirrhotic PHT.

To improve the method of autologous kidney transplantation model construction in Beagle dogs and to summarize the experience of successful establishment of the model.

Eighteen adult Beagle dogs were randomly divided into sham operation group and model group, with 9 dogs in each group. The left kidney was preserved and the right kidney was removed in the sham operation group. The model group received autologous heterotopic left kidney transplantation and the right kidney was removed. The experimental operators were all from the same group of physicians. The serum creatinine and urea nitrogen were detected at 8 am on day first, second, third, fifth, seventh, tenth, 13th, 16th, 19th, 22th, 25th and 28th postoperatively. Two independent samples t-test were used to compare serum creatinine and urea nitrogen of Beagle dogs sham operation group and model group within 28 days after operation. P<0.05 was considered statistically significant.

One experimental dog in model group was dead due to the serum creatinine continued to rise without any improvement. Euthanasia was performed on the 7th day after kidney transplantation. Anatomy revealed renal artery thrombosis and necrosis of the transplanted kidney. The serum creatinine and urea nitrogen of the other 8 dogs in the model group increased briefly on the second day after surgery, and then gradually decreased and remained stable. The serum creatinine and urea nitrogen of the other 8 dogs in the model group were higher than those in the sham operation group on the first, second, third, fifth, seventh, tenth, 13th, 16th and 19th days after kidney transplantation, and the differences were statistically significant (t=-4.544, -5.083, -5.171, -4.946, -5.460, -5.345, -3.757, -3.918 and -3.435; t=-4.810, -8.119, -10.379, -12.789, -15.210, -9.983, -5.014, -4.599 and -2.657, all P<0.05). Model group was euthanized after 28 days of observation. Anatomical results showed that the size of the transplanted kidney was about 7 cm×4 cm×2 cm, the texture was moderate, there was intestinal encapsulation around the kidney, there was no thrombosis in the renal artery and internal iliac artery, and the renal vein and external iliac vein returned normally. The blood flow of the reconstructed vessels was good, and no stenosis was observed at the ureter and bladder anastomosis. In the sham operation group, no abnormalities were observed after anatomy, the remaining left kidney showed normal anatomical shape, and the morphological structure and position relationship between renal artery, renal vein and ureter showed normal physiological state. HE staining of transplanted kidney tissue of experimental dogs in model group showed slight changes in renal tissue structure, uniform distribution of glomeruli and no abnormal changes in Baumann′s bursa. The epithelial cells of renal tubules were square or columnar, with abundant cytoplasm, intact lumen structure and no obvious injury. Neutrophils and plasma cells were observed in the renal pelvis of 3 dogs in model group.

The perioperative management method of autologous kidney transplantation in Beagle dogs was successfully explored through the experiment, which could make the animal model simple, stable and repeatable.

To compare the effect of transcatheter arterial chemoembolization (TACE) therapy on tumor recurrence and survival in liver transplant recipients with hepatocellular carcinoma (HCC) who met Hangzhou criteria.

The clinical data of 92 liver transplant recipients with HCC who met the Hangzhou criteria and underwent liver transplantation in the 900th Hospital of the Joint Support Force of Chinese People′s Liberation Army from January 2008 to December 2018 were retrospectively analyzed. All recipients were confirmed to have HCC by postoperative pathological examination. Recipients were divided into TACE treatment group (n=58) and direct transplantation group (n=34) according to whether they received TACE treatment before liver transplantation. Measurement data conforming to normal distribution were compared by group t test, measurement data not conforming to normal distribution were compared by Mann-Whitney U test, and enumeration data were compared by chi-square test or Fisher exact test. Survival analysis was performed using the Kaplan-Meier method and compared using the log-rank test. P<0.05 was considered statistically significant.

During the follow-up until December 31, 2021, the average postoperative follow-up time of 92 recipients was (77±48) months, and a total of 32 recipients had tumor recurrence during the follow-up period. Nine of the 92 recipients had preoperative portal vein tumor thrombus (PVTT), none of whom were found to have portal vein invasion by preoperative imaging, and postoperative pathology revealed the presence of venular tumor thrombus, which belonged to PVTT type Ⅰ₀. Of the 9 recipients, 6 had tumor recurrence after transplantation, with a mean disease-free survival time of (51±48) months, and 7 recipients died, with a mean survival time of (62±43) months. The survival rates at 1, 3 and 5 years after operation were 96.6%, 84.5% and 82.8% in TACE group and 91.2%, 67.6% and 61.8% in direct transplantation group, respectively. There was no significant difference in the survival rates at 1 and 3 years after operation between the two groups (χ²=1.205 and 3.571, all P>0.05). There was significant difference in the survival rate at 5 years after transplantation between the two groups (χ²=5.039, P<0.05). The postoperative 1-, 3- and 5-year disease-free survival rates were 87.9%, 77.6% and 75.9% in TACE group and 76.5%, 58.8% and 52.9% in direct transplantation group, respectively. There was no significant difference in the postoperative 1- and 3-year disease-free survival rates between the two groups (χ²=2.063 and 3.639, all P>0.05). There was significant difference in the postoperative 5-year disease-free survival rate between the two groups (χ²=5.124, P<0.05). There were significant differences in the postoperative survival rate and postoperative disease-free survival rate between the two groups (χ²=5.013 and 5.406, all P<0.05).

For liver transplant recipients with liver cancer who meet Hangzhou criteria, preoperative TACE treatment may improve the long-term efficacy after transplantation.

To analyze the perioperative characteristics of lung transplantation (LT) recipients, and to enhance the experience of LT.

The clinical data on 50 consecutive brain-dead donor at Lung Transplantation Center of China-Japan Friendship Hospital from March 1 to December 31, 2017 were retrospectively collected. The median age of recipients was 63 years (27-71 years), including 43 males and 7 females. Thirty-one single LT (SLT) recipients and 19 bilateral LT (BLT) recipients were enrolled. Thirty-eight donors′ age was between 16 to 55 years (median age 37 years). Median PaO₂/FiO₂ was 444 mmHg (313-600 mmHg, 1 mmHg=0.133 kPa) before donation with ABO compatibility between all donors and recipients. We used Chi-square test or Fisher exact test to compare the perioperative death rate between different groups of age, sex, procedure type, body mass index, primary diseases, blood loss and extracorporeal membrane oxygenation (ECMO) support. Bonferroni method was used to adjust α level in pairwise comparison. Overall survivals of different groups at one year were described by using Kaplan-Meier curves, and Breslow test was used to compare the survival curve between the two groups. A P<0.05 was considered statistically significant.

Median perioperative ECMO support time was 2.0 d (0.3 d-13.0 d) in 40 recipients. Median ICU stay time was 4 d (1-60 d). Perioperative survival rate was 84%(42/50), with survival time being 1-49 d in 8 recipients. Perioperative survival rates in BLT and SLT were 31.6% (6/19) and 6.5% (2/31), respectively (P=0.041). One year survival rate in all recipients was 78% (39/50), while it was 87.1% in SLT and 63.2% in BLT, respectively (P<0.05). There were different Kaplan-Meier curves in subgroup of age, primary diseases and ECMO support (P all <0.05). Ten recipients (20%) had donor derived infection. Nine patients (18%) developed airway complications with bronchial stenosis following LT, which 2 patients complicated with anastomotic fistula.

Patients with end-stage lung disease can benefit from LT at appropriate time point and comprehensive appreciation and management.